乙型肝炎病毒相关慢加急性肝衰竭患者肝纤维化、肝功能、病毒学指标及甲胎蛋白水平与预后的关系

目的初步探讨乙型肝炎相关慢加急性肝衰竭(HBV-ACLF)患者血清肝纤维化、肝功能、病毒学指标及甲胎蛋白(AFP)水平与预后的关系。方法根据预后将185例HBV-ACLF患者分为好转组(116例)和无效组(69例),检测血清肝纤维化和肝功能指标、病毒学指标、AFP水平,分析肝纤维化等指标与预后的关系。结果好转组和无效组性别、HBV基因型、HBeAg阳性率、HBV DNA载量、ALT、Alb、CHE比较差异无统计学意义。好转组和无效组平均年龄分别为(43.3±10.1)岁和(48.7±10.1)岁,TBil分别为(295.9±99.6)μmol/L、(355.4±136.8)μmol/L,凝血酶原活动度(PTA)分别为(34.5±7.9)%、(30.4±7.6)%,AFP分别为85(9～4760)ng/L、26(4～529)ng/L,差异皆有统计学意义(P值分别为0.006、0.009、0.0007、0.000),肝纤维化指标中,透明质酸(HA)、Ⅲ型前胶原(PcⅢ)与Ⅳ型胶原(C-Ⅳ)好转组和无效组差异无统计学意义,层粘连蛋白(LN)好转组和无效组分别为657(45～1616)μg/L、306(29～1724)μg/L,差异有统计学意义(P<0.001)。结论血清LN、AFP、TBil、PTA水平、年龄可能对HBV感染慢加急性肝衰竭患者的预后判断有一定意义。

Relation of liver fibrosis indicators and prognosis in hepatitis B - related acute on chronic liver failure

Objective To study the relation of liver fibrosis indicators and prognosis in hepatitis B virus-related acute on chronic liver failure(HBV-ACLF).Methods One-hundred-eighty-five cases of HBV-ACLF diagnosed and treated between October 2008 and October 2010 were classified according to prognosis: improved group(n=116) and ineffective group(n=69).Serum markers of liver fibrosis,virus replication,and liver function were measured to analyze their relation with prognosis.Results There was no difference in sex,HBV genotype,positivity rate of HBV e antigen,HBV DNA load,or levels of alanine aminotransferase,albumin,cholinesterase,hyaluronic acid,type IV collagen,or human procollagen peptide III between the improved and ineffective groups.However,the improved group showed higher average age(years: 43.3±10.1 vs.ineffective group: 48.7±10.1,P=0.006),level of total bilirubin(TBil;μmol/L: 295.9±99.6 vs.355.4±136.8,P=0.009),prothrombin activity(PTA;%: 34.5±7.9 vs.ineffective group: 30.4 ±7.6 P=0.0007),alpha-fetoprotein(AFP;ng/L: 85(range: 9-4760) vs.ineffective group: 26(4-529),P<0.001),and laminin(LN;μg/L: 657(45-1616) vs.306(29-1724),P<0.001.Conclusion LN,AFP,TBil and PTA levels and age may be effective prognostic markers for HBV-ACLF patients.